Phone consultations are dodgy enough, says Phil, but email is beyond ridiculous.

As reported in Pulse last week, just 36 GPs have signed up to a Department of Health pilot scheme to allow patients to access their GP via email. And 89 patients. Even by the disastrous standards of Government IT projects, this can hardly be regarded as a success. So far, £11bn of our taxes have been fruitlessly widdled away on unworkable and unwanted schemes as part of the NHS National Programme for IT. It’s not like we couldn’t use the cash elsewhere.

The medical director of the NHS, Sir Bruce Keogh, has said he is keen to encourage GPs to use technology to consult with patients. ‘Once you have online consultations, it breaks down geographical boundaries. It opens up the spectre of 24/7 access,’ he has said. Given that he appears to think that this is desirable, his choice of the word ‘spectre’ is interesting.

It’s a wonder they could find even 36 GPs prepared to countenance this daft idea. The disadvantages will occur to most of us immediately and there are too many to enumerate in full, but consider just two obvious ones. We already have face-to-face consultations, telephone calls, a pile of results to sift, an ever-increasing heap of paper letters to read and a daily list of ‘tasks’ that relentlessly appear on the computer desktop. Why would we welcome yet another stream of will-sapping work activities? And, given the nature of emails, how would we verify the identity of the person we think we are communicating with?

It cannot be done, pure and simple.

In our practice, even telephone consultations are a step too far. I know of GPs who will spend an entire afternoon racking up their phone bills, chasing patients, leaving messages, getting engaged tones, and finding that the person requiring ‘urgent’ advice has switched their mobile off. A phone call is a flawed method of communication for all but the simplest of tasks. Mistakes are made, obvious visual symptoms and signs are missed, and vital physical and non-verbal cues are simply not there. Why do many GPs put themselves at such an unnecessary disadvantage? In our practice, the phone is for taking messages. It is not a consultation tool.

The use of IT, particularly the phone, is reaching a new level of absurdity. Our local physiotherapy department has ceased to take written referrals from GPs and now insists we give the patient a phone number to make their own appointment. In fact, as anyone at all is encouraged to do this without the advice of a doctor (and this is made explicit on the leaflets we have been given) the GP is removed from the process altogether.

I saw a gentleman the other day who had been through this process.

‘How did the physio go?’ I asked him.

He was nonplussed. ‘Well doctor, I’m not sure. I spoke to this bloke on the phone and he asked questions about my shoulder, then told me some exercises to do with a brick. It’s not really helping, to be honest.’

It beggars belief that anyone believes a hands-on activity like physiotherapy can be delivered down a phone line without ever setting eyes on the patient, but this is what we are reduced to. It really is too ridiculous to contemplate.

Phil’s personal mission to eradicate home visits comes under unexpected challenge – as he is asked to protect a patient from a resident ghost

The general practice war against home visits, like the military War Against Terror or the political War Against Drugs, is not a war we can ever expect to win. On the other hand, this does not mean that it is a war not worth fighting.

In the 17 years I have been a partner in my practice, I have seen the home visiting rate fall from an average of four visits per partner per day, to less than one. This partial victory has not been achieved without blood, sweat and tears. Some of those have even been mine.

Our practice leaflet is explicit: ‘Home visits are available to all our patients,’ it says, in a very small font at the bottom of the page. ‘You will need to have been certified as terminally ill by at least two medical professionals of consultant grade. Please telephone and make your request between 9.00 and 9.06 in the morning. If you are under 60 and able to stand upright, you will need to be extremely polite and persuasive. If you are requesting a visit on behalf of a child, go on, pull the other one; it’s got bells on it. If Dr Peverley is on call, none of the above applies anyway.’

Despite the gently discouraging tone, home visit requests continue to arrive.

My favourite is the old lady who arrived at our front desk in her dressing gown, complaining that she couldn’t get through on the phone. She demanded

that someone should come out and visit her straight away, as she was ‘absolutely

flat out’.

Another lady, rather younger, requested a home visit from me just the other day.

I was rather nonplussed by her request, as she was sitting in front of me in my consulting room at the time.

‘I feel a bit silly asking this doctor, but would you come out and visit me at home later this week?’ she asked. I scrutinised her face intensely. She didn’t appear to be joking.

‘It would be rude of me to refuse immediately,’ I countered. ‘Please explain your request in considerably more detail, and I promise I won’t slap my knee, cackle wildly and point dismissively at the door until you’ve finished spouting whatever hopeless nonsense you’re just about to emit.’

‘There’s a ghost in my house. The doors keep opening and closing and the air goes freezing cold. I don’t know what to do. Last night I dreamt there was a man on my bed.’

‘Among young ladies, this dream is not unheard of,’ I said.

‘Yeah, but this bloke was dead.’

I paused for thought. To be honest, it did cross my mind for a couple of seconds to take this garbage seriously, but the impulse didn’t last long. I’m an old hand these days. Basically, I genuinely can’t be arsed.

‘Look, I’m a GP. I treat illnesses, I prevent illnesses; I’m a secular priest and a reluctant portal to the benefits culture.

I have no hotline to the afterlife. Assuming you have a ghost and not, say, a central heating problem, exactly what do you expect me to do? Treat it for phantom pains? Should I try to improve your spirits? Come on, come on, come on. Gimme a break here!’

She sighed. ‘I suppose you’re right. You don’t have to visit. So, if you’ll just give me a letter for the housing department stating that I need rehousing to get away from the ghost, I think that would be okay instead.’

The pieces of the jigsaw finally fell into place. I slapped my knee, cackled wildly and pointed dismissively at the door. ‘Good effort,’ I advised her. ‘I am impressed. But I would rather lead apes in hell.’

Dr Phil Peverley is a GP in Sunderland